I wish u knew… providing care at the end of life is a privilege

The best interviews are the ones who take my questions and figure out what the real questions are.

In the case of “What do you wish people knew about you or your work?” Dr. Bruce Giantonio quickly cut away the unnecessary verbiage designed to coat my desire for him to just tell me something compelling. You can’t just stick a camera in someone’s face and say, “tell me something compelling.”

Fortunately, something compelling is exactly what you can expect from Dr. G.

“I think your question in a broader sense touches on that–what keeps us going?” he said.

Exactly. What’s a charming man like Bruce–crisp-collared and stylish, with Matisse on the walls of his office, affable, serene, well spoken, and steely-eyed–doing in a place like this? Why treat cancer? Why not throw up your hands and go sell real estate? Adopt a pet and collect some more Matisse. Travel, die happy.

Because he made a promise.

It goes like this: Society “confers upon physicians a tremendous amount of privilege,” meaning physicians “get to work with people in a way that not many other people get to do.” To Bruce, that privilege comes at a cost. He has to spend his career walking the line between chivalry and egotism, always making sure to “respect that privilege,” but also making sure to never let it go to his head. For an example of him actively doing it, go to around 52 seconds in his “On Being a Physician” video. “Curing somebody is a phenomenal feeling,” he says as he arches his eyebrows like somebody just offered him dessert and a back massage. “But I think we have to be careful with that too. You can easily have your ego…you can easily get carried away.”

The lacunae that punctuate Bruce’s speech draw his chosen sentiments into broad moral themes sketched to seem plain and honest. He is just as expressive in his fits of silence as he is when he speaks from the heart. Maybe that part of his personality is the part that likes French impressionism, which produces the optical impression of detail where there are only strokes of paint, or no strokes of paint, and a picture as vivid as your mind allows.

The language he uses to describe his thoughts and responsibilities is more often normative than personal. He was never reflecting only on what keeps him going as a medical oncologist. From the very beginning, it was we. “What keeps us going?” he asked. “There are so many things that can inspire you to keep going. And I think that’s true of all of us.” “We are still servants of the people we‘re taking care of.” The community of servants to which he belongs is the source of his inclusivity. Bruce, as dedicated as he is to curing patients, feels as if there’s a kind of art to being a doctor. Like many other arts, the most exciting part is the pursuit of what to do with it. What does it mean to be one of these people with the power to save lives?

And what does it mean to be one of these people who can’t always use that power when they want to?

“It is difficult. We do cure people, but many people we don’t.” Bruce glided into the subject comfortably. It’s a part of the mantle he took up with the Hippocratic oath, and he has been living with it as his albatross for years. He knows its weight.

“It isn’t always a depressing thing to be involved with,” he told me. “The way I look at it is it’s almost a privilege to be involved with their life, at the end of their life.”

There’s that privilege again. By counting everything as a privilege to be upheld and rightly deserved, Bruce avoids the rust that can dull him as a man of science. It also ensures that every time he has to break bad news, something he describes as “the hardest part of his job,” he feels it.

“You have a role in determining how that period of their life plays out,” he said. What we tend to forget is that caring for someone who will certainly die is not like awarding a lesser version of medical care to a subject who has become unworthy of the hunt for a cure. From talking to Bruce, I learned that it’s really the same for all patients. Doctors, by enrolling in their practices, are transported directly to crucial moments in the lives of the sick. Each moment is crucial for its own reason, and each doctor “thinks a lot about that”–”that” being “how best to proceed.” Patients all get everything from their doctors. Everything.

Bruce’s fascination with not just his medical profession, but the medical profession, applies to the future of oncology as well as its day-to-day ethics. “I always joke I’d like to be here 200 years from now to see how disease is managed,” he said. “It’s just going to be vastly different than anything we do right now. Vastly.”

I have a feeling that Bruce will get his wish, even if he’s long gone after 200 years. As long as there are doctors who remain committed to the “we,” the “us,” of medicine, as long as men and women seek to shirk their egos and live nobly, to treat and cure and see the departed across the Styx, there will be a Bruce around.